VBAC stands for Vaginal Birth After Cesarean. It refers to the vaginal birth of a baby after having had a caesarean section (C-section) in a previous pregnancy. Depending on how many Caesareans have been had the count may go up like this VBA2C, VBA3C etc. A Home birth after Caesarean is a HBAC, and a Free birth after caesarean is a FBAC. Whew!! Please note I am choosing not to use the term successful here and instead using the term completion. I am doing this because the terms successful and failed VBAC implies a judgement that most women can do without. It also adds a pressure and sense of competitiveness to the birth that can have negative effects. 

Common Misconceptions about VBAC

1. "Once a C-section, always a C-section." This is not true. For many women, VBAC is a safe and viable option. In fact, the completion rate for VBAC when chosen and labour begins is around 60-80% but can be lower or higher depending on the care provider chosen. 

1. "VBAC is too risky." While there are some risks associated with VBAC, they are generally low. The most serious risk is uterine rupture, but it occurs in less than 1% about 0.7% of VBAC attempts. That number increases to 2-3% if the labour is induced (forced to start) or augmented (pushed along at a faster pace) with synthetic oxytocin. 

1. "VBAC is not possible if you have had multiple C-sections." This is also not entirely true. While the chances of completion may be lower with multiple C-sections, VBAC can still be considered, and completion rates vary depending on individual circumstances.

1. "VBAC is only for women who have a 'natural' reason for their first C-section." This is false. VBAC can be a safe option for women regardless of the reason for their previous C-section.

3. Medical Evidence for VBAC

   Benefits for mother

   • Reduction in surgical risks: VBAC avoids the risks associated with abdominal surgery, including infection, haemorrhage, and scarring.

   • Shorter recovery time: Mothers who deliver vaginally typically recover faster and experience less pain than those who have a caesarean section.

   • Decreased risk of maternal complications: VBAC may be associated with a lower risk of certain maternal complications, such as placenta previa and placenta accreta.

Potential psychological benefits: Some women feel fulfilled emotionally after a VBAC, experiencing it as a boost to their confidence in their body and their ability to trust themselves.

Enhanced Sense of Empowerment and Control

Completing a VBAC can fulfil a deep desire for agency and control in the birth experience, which might have felt lacking during the previous caesarean section. Women often report feeling proud of their body's strength and resilience, overcoming fears and medical uncertainties surrounding VBAC. This confidence can extend beyond childbirth, impacting other areas of life and fostering a sense of self-efficacy.

Improved Maternal Self-Esteem and Body Confidence

The physical act of vaginal birth can be perceived as a reclamation of one's body and its capabilities, potentially reversing feelings of vulnerability or passivity experienced during a caesarean section. The fulfilment of a desired birth plan strengthens self-worth and body acceptance, especially after facing medical interventions or societal pressures regarding VBAC attempts. This improved body image can positively impact postpartum experiences, like breastfeeding and physical recovery.

Reduced Emotional Distress and Risk of Postpartum Depression

Studies suggest that VBAC attempts, both complete and incomplete, are associated with a lower risk of postpartum depression (PPD) compared to planned repeat caesarean sections. This may be due to the feelings of empowerment, control, and positive self-perception mentioned above, along with potentially lower rates of surgical complications and faster postpartum recovery. Reduced stress and anxiety related to birth choices and medical interventions can also contribute to improved mental well-being. Indeed, much of the diagnosed PPD is birth trauma. Ideally seek therapeutic support for birth trauma before the next birth and even potentially conception.

Stronger Bonding with Baby and Enhanced Emotional Connection

Some women report feeling a more immediate and powerful connection with their babies after a VBAC, attributing it to active participation in the birth process. The natural hormonal cascade triggered by vaginal birth can contribute to maternal bonding and nurturing instincts. The sense of accomplishment and self-reliance associated with VBAC can further strengthen the mother-baby bond, fostering a positive and confident parenting approach

Positive Impact on Future Pregnancies and Birth Choices

A completed VBAC can increase confidence and trust in one's body for future pregnancies and birth experiences. Women may feel more open to considering natural approaches to pregnancy and childbirth, breaking free from potential anxieties about needing caesarean sections in subsequent pregnancies. The positive emotional memory of VBAC can empower women to advocate for their birth preferences in future encounters with healthcare providers.

It's important to note that individual experiences of VBAC vary greatly, and some women may not experience all of these benefits. Indeed in my experience, there are often feelings of guilt associated with the giving of gentle birth to the vaginally birthed baby and not the caesarean birthed baby. A VBAC will not take away the trauma of a previous birth. That needs to be dealt with on its own.

BENEFITS FOR THE BABY

• Lower risk of respiratory problems: Newborns delivered vaginally have a slightly lower risk of respiratory distress syndrome compared to those delivered via caesarean section.

• Exposure to beneficial bacteria: During vaginal birth, babies are exposed to beneficial bacteria from the mother's birth canal, which may help boost their immune system.

• Potential breastfeeding benefits: Some studies suggest that mothers who deliver vaginally may have an easier time initiating and maintaining breastfeeding.

• Higher pain relief levels: Vaginal birth provides several benefits for newborns, such as improved respiratory and cardiovascular functions. Hormones released during labour may help reduce pain for the baby. A study found that infants born vaginally have lower brain activity in response to pain compared to those born by caesarean section. This may be linked to the stress of birth and the production of a hormone called copeptin. Infants experiencing foetal distress during birth may have higher pain responses. Additionally, stress levels during birth can affect the analgesic benefits of hormones like vasopressin. The study suggests that the stress associated with normal vaginal delivery may lead to increased production of foetal vasopressin, providing natural pain relief for the baby. However, in cases of significant foetal distress, this analgesic effect may be less effective. The study acknowledges some limitations and calls for further research to explore these findings. (Kasser et al. 2019)

• RISKS FOR THE MOTHER

  • Uterine rupture: The most serious risk associated with VBAC is uterine rupture, which occurs when the scar from the previous caesarean section tears. While the risk is relatively low (generally <1%), it can have serious consequences for both mother and baby. When uterine rupture does occur the maternal mortality rate for those less than 1% is less than 7%. That equates to a 0.007% chance of maternal death from uterine rupture (Astatikie 2017) That number is for all women including those who are receiving augmentation and those with no scar on their uterus. Yes that’s right, uterine rupture is possible whether there is a scar or not, and is a higher risk for women being augmented with no scar than for an unmedicated VBAC.

  Uterine Rupture vs. Window and Dehiscence: A Birthing Partner's Guide

  Imagine your uterus as a stretchy balloon. During pregnancy, it inflates to accommodate your growing baby. After a C-section, a scar forms like a stitch on the balloon. But what if the stitch stretches or even pops? That's where uterine rupture, window, and dehiscence come in.

  Uterine Rupture: The Big One (Thankfully Rare)

  Think of a complete tear in the balloon. That's uterine rupture, a serious but uncommon event where the entire scar splits open through all three layers of the uterus. It can be scary, but it's important to remember it's rare, happening in only about 1 in 200 pregnancies after a C-section. It is slightly higher for women with 2 or more caesareans, though the maternal mortality rate is the same as for continued repeat caesarean sections.

  Uterine Window: The Thin Stretch

  Picture the balloon getting really thin at one spot, almost transparent. That's a uterine window, where the scar stretches so much you can almost see through it. Unlike a tear, it doesn't break open, but it can be concerning. However, research suggests it might not increase the risk of rupture. Many mamas with window babies have successful VBACs without even knowing about it!

  Uterine Dehiscence: The Partial Peel

  Think of a scab lifting slightly at one edge. That's uterine dehiscence, where the scar partially opens in the bottom layer, stretching but not tearing completely through. This is also uncommon and often harmless, with no impact on mom or baby.

RISKS FOR THE BABY

• Foetal distress: VBAC carries a slightly higher risk of foetal distress compared to caesarean section, although the absolute risk is still low. This may have to do with the interventions in labour and, the position of the mother during labour and it could also be the variation of parameters used to determine foetal distress. A quick search will give lower range numbers of beats per minute from below 100 to below 120 bpm for bradycardia. The top rate is higher than 160 bpm to 180 bpm for tachycardia. There is also significant research suggesting that the diagnosis of foetal distress is often flawed, inconsistent and inaccurate. (Let's talk more about monitoring for VBAC later.)

• Uterine rupture: For women considering a VBAC, the odds of infant death are reassuringly low. The National Institute of Health (USA) reports a risk of just 0.13%, meaning one loss for every 769 VBACs attempted. This compares favourably to the U.S. average neonatal mortality rate for 2014, which was significantly higher at 5.8 deaths per 1,000 births (one in 172).

The Takeaway

Knowing the differences between these terms and their risks can help you and your partner make informed decisions with your healthcare provider. Remember, open communication and a supportive team are key to a safe and empowering birthing experience.

BONUS TIPS FOR BIRTHING PARTNERS

• Ask questions: Don't hesitate to ask your healthcare provider about your specific situation and risks, but get numbers and facts that can be backed up. It isn’t useful to get an answer like “Well the risk is 3 times higher.” What you want to know is the risk of uterine rupture is .07% unmedicated and 2.2% with synthetic oxytocin. That’s a figure you can gain clarity from and it doesn’t place a value judgement on it. It leaves it up to the birthing family to determine their risk assessment.

• Research VBAC: Learn about the benefits and risks, and find supportive communities and resources. Be discerning about who you listen to, follow the money, check the experience, and check the credibility.

• Trust your instincts: If you have any concerns during pregnancy or labour, speak up immediately.

• Other complications: Vaginal birth may also increase the risk of other complications, such as haemorrhage, infection, and shoulder dystocia (difficulty delivering the baby's shoulder). This is true for any vaginal birth and not specific to VBAC.

• Increased desire for intervention by care providers: Women planning VBAC may be more likely to face a strong desire by caregivers for extra interventions during labour, such as epidurals, cannulation, constant monitoring and assisted birth. We will discuss these later as well as the evidence for them.

PLANNED REPEAT CAESAREAN BIRTH (RCS)

Pros:

• Controlled birth: A scheduled date ensures the baby is delivered in a controlled environment.

• Reduced pain during labour: No need to experience labour pains, although to allow a baby to choose its time of birth some families will wait till labour begins.

• May be recommended for medical reasons: Certain medical conditions necessitate a C-section, eg. complete Placenta previa.

• Lower risk of certain complications: Can avoid risks associated with vaginal birth, like perineal tearing.

Cons:

• Major surgery: Involves surgery with associated risks and recovery time, and the pain associated with it.

RISKS FOR THE MOTHER

• Infection: Both the wound and the lining of the uterus (endometritis) can become infected, causing fever, pain, and abnormal discharge.

• Excessive bleeding: While bleeding during surgery is normal, uncontrolled bleeding might necessitate transfusions or further surgery.

• Blood clots: The risk of deep vein thrombosis (DVT) in the legs or pelvis increases after a C-section, potentially leading to dangerous pulmonary embolism if the clot travels to the lungs.

• Reactions to anaesthesia: While rare, allergic reactions or side effects like nausea, dizziness, and memory issues can occur.

• Surgical injury: Though uncommon, damage to nearby organs like the bladder or bowel can happen during the procedure.

• Post-surgical pain: The incision site can cause significant pain, requiring pain medication and hindering mobility for some time and driving for 6 weeks typically.

• Longer hospital stay: Compared to vaginal birth, C-sections typically require 3-5 days of hospitalisation for recovery. When someone is coming in to wake you frequently and there is banging in the hallways, beeping machines etc. it can be hard to get rest even when your baby is sleeping. Other children you may have also need to be considered here.

• Slower recovery: Takes longer to recover from surgery than from natural labour.

• Increased risk of complications in future pregnancies: Repeated C-sections can increase the risk of certain complications.

TYPES OF COMPLICATIONS

• Placenta Previa

  • Definition: Placenta previa occurs when the placenta implants itself in the lower part of the uterus, partially or completely covering the cervix. The risk increases with each C-section, reaching about 5% after three or more.

  • Risks: This abnormal position can lead to painless vaginal bleeding, especially in the late second or third trimester. Placenta previa can also increase the risk of:

  • -Preterm delivery

  • -C-section delivery

  • -Haemorrhage after delivery (postpartum haemorrhage)

  Placenta Accreta

  • Definition: Placenta accreta is a more serious condition where the placenta grows too deeply into the uterine wall. It's a spectrum disorder, with three degrees of severity:

  • Placenta accreta: Placenta attaches deeply in uterine wall.

  • Placenta increta: The placenta attaches to the myometrium, the muscle layer of the uterus.

  • Placenta percreta: The placenta penetrates through the uterine wall and can adhere to other organs.

  • Risks: Placenta accreta can lead to:

  • -Severe haemorrhage after delivery, which can be life-threatening

  • -Difficulty delivering the placenta

  • -Need for a hysterectomy (surgical removal of the uterus)

  • 
    Placental abruption: The placenta detaches from the uterine wall before delivery, potentially causing oxygen deprivation to the baby and severe bleeding for the mother. The risk is slightly higher with each C-section, especially if previous surgeries involved placenta previa.

• Uterine rupture: The scar tissue from previous C-sections weakens the uterine wall, increasing the risk of tearing during labor. This risk is low (around 1% after one C-section) but increases with each subsequent C-section.

• Other complications: These include bladder or bowel injury during surgery, blood clots, infection, and increased risk of needing another C-section in future pregnancies.

• The decision of whether to have a repeat caesarean section (RCS) can be a complex one, and it's important to weigh the potential risks and benefits for both you and your baby. Here's a breakdown of what you need to consider for the baby:

• BENEFITS FOR THE BABY

  Reduced risk of complications during birth: Compared to vaginal birth after a previous C-section (VBAC), RCS can minimise the risk of certain complications for the baby, such as:

  • Foetal distress during labour: This can occur if the baby receives insufficient oxygen during labour, potentially leading to brain damage. See cons for where this occurs in RCS

  • Cord prolapse: This is when the umbilical cord slips through the cervix before the baby, cutting off oxygen supply. (a risk in all vaginal births not exclusive to VBAC)

  • Uterine rupture: This is a rare but serious complication where the scar tissue from the previous C-section tears, putting the baby at risk. It can still occur in the pregnancy, however.

  • Faster delivery: RCS is typically a quicker procedure than vaginal birth, which can be beneficial in situations where the baby needs to be delivered quickly due to health concerns.

  RISKS FOR THE BABY

  • Increased risk of respiratory problems: Babies born via C-section may be more prone to respiratory issues like transient tachypnea of the newborn (TTN) due to less exposure to vaginal flora and bacteria. Initially due to exposure to anaesthesia and bypassing the squeeze of a vaginal birth.

  • Increased risk of long-term health problems: Studies have shown a potential link between C-section deliveries and an increased risk of certain health conditions in children later in life, such as asthma, obesity, and allergies. However, the evidence is still evolving and more research is needed.

  • Increased risk of complications from surgery: As with any surgery, there are general risks associated with RCS for the baby, such as infection, bleeding, injury (forceps are sometimes needed during caesareans and lacerations from surgical knives are a rare but present risk), and medication side effects.

  • Delayed bowel movements in newborns: Newborns naturally pass their first meconium stool, a sticky, dark green substance, within the first 48 hours after birth. However, babies delivered via C-section may experience some delay in passing their first stool compared to vaginally delivered babies. This delay can range from a few hours to a few days and is generally not worrisome unless accompanied by other symptoms. Possibly due to a lack of exposure to maternal gut bacteria: During vaginal delivery, newborns are exposed to maternal gut bacteria, which helps seed their gut microbiome and stimulates bowel movements. This exposure is limited in C-section babies, potentially delaying their digestive system's activation. Some hospitals will facilitate seeding immediately following a caesarean others will not. Pain medication exposure may also contribute. Narcotic pain medications given to mothers during C-sections can slow down intestinal movement in both mother and baby, leading to temporary constipation. C-section mothers are more prone to dehydration, which can affect milk production and subsequent intake in the baby, potentially leading to constipation. Breastfeeding newborns naturally receive prebiotics and gut bacteria from their mother's milk, which aids digestion. Babies solely relying on formula may experience slower bowel movements initially. Research indicates there is a link between breastfeeding complications and caesarean birth due to the lack of naturally produced hormones that facilitate birth and then breastfeeding and bonding. and medical conditions. In rare cases, underlying medical conditions like Hirschsprung's disease (absence of nerve cells in the colon) or meconium ileus (thickened meconium obstructing the intestines) can cause delayed bowel movements, regardless of delivery mode.

  • Respiratory distress: Babies born through C-section might have a slightly higher risk of breathing difficulties initially due to exposure to anaesthesia and bypassing the squeeze of a vaginal birth.

  • Feeding challenges: Difficulty latching or sucking may be more common in C-section babies due to sedation from anaesthesia.

It's important to approach this topic with sensitivity and avoid judgmental language. Focusing on validating women's experiences, providing accurate information, and encouraging them to seek support can be immensely helpful in navigating the emotional complexities of unexpected C-sections. Saying things like “at least we have a healthy baby” doesn't help. It can cause a woman to feel less heard, less important, and ungrateful.

The concept of a "healing" or "redemptive" birth after birth trauma or a caesarean section (C-section) can be complex and nuanced, with various factors influencing its potential impact on maternal mental health. While some women may find it a valuable tool for processing and overcoming any emotional challenges associated with their C-section experience, others may find it challenging or even detrimental. The concept of another birth being a redemptive birth is rife with danger as it firstly assumes that the birthing woman has failed and needs to redeem herself, and if things don't go to plan further implies that she is unworthy. Instead, it may be more helpful to view each birth as a journey unto itself. Each requires healing, preparation, and attention.

Here are some key points to consider:

POTENTIAL BENEFITS

• Processing trauma: For some women who experienced a traumatic C-section, a healing birth can seem like a way to reclaim control over their birth narrative and process any emotional distress. This is seldom truly possible, what can be shifted during another birth is self-confidence. The previous birth experience however requires its attention and healing to be truly beneficial long term. Processes such as TRTP (The Richards Trauma Process) can remove the emotional charge from past experiences. So whilst the person will remember that the event was painful, they will no longer experience pain at the remembering.

• Closure: Engaging in a closing of the bones ceremony or other closing experience can guide women to feel like they still had a meaningful birth experience, even if it wasn't the one they initially envisioned. It can also provide a sense of closure and acceptance of their C-section.

• Community and support: Connecting with other mothers who have had C-sections and engaging in shared healing practices can provide valuable support and understanding.

POTENTIAL CHALLENGES

• Unrealistic expectations: The concept of a "healing" birth can set unrealistic expectations, leading to disappointment or further emotional distress if it doesn't live up to those expectations. It's crucial to remember that healing is a personal journey and takes time and emotional effort.

• Triggering memories: Some aspects of a healing birth ritual, such as holding a baby doll or visualising pushing, could inadvertently trigger traumatic memories for some women. It's important to approach these practices with caution and awareness of potential triggers. Not all processes use these tools so it is important to choose wisely.

• Pressure and guilt: The emphasis on a "healing" birth can put pressure on women to feel like they need to engage in these practices, even if they don't feel comfortable or ready. It's important to prioritise individual well-being and avoid feeling pressured into anything that feels harmful.

• Redemptive or healing birth culture: The culture of having a healing or redemptive birth to correct previous “failures” implies fault lies with the woman alone and the need to prove oneself.

Overall:

The potential benefits and challenges of a healing or redemptive birth after a C-section are unique to each woman and depend on her individual experience and emotional needs. It's important to:

• Listen to your intuition: Do what feels right and comfortable for you, without pressure from others.

• Seek support: Reach out to mental health professionals or support groups specialising in C-sections and postpartum mental health.

• Focus on self-care: Prioritise your own well-being and emotional needs, choosing a therapy outside of your next birthing experience.

Remember

Every woman's experience is unique, and the presence or absence of these impacts doesn't define anyone's journey.

Seeking professional support from a therapist or counsellor specialising in perinatal mental health is crucial for processing emotions and developing coping mechanisms.

Connecting with support groups or online communities of women who've had C-sections can provide valuable understanding and connection.

Here are some additional resources that may be helpful

• The Caesarean Section Awareness Network (CSAN): https://www.csan.org.uk/

• Postpartum Support International (PSI): https://www.postpartum.net/

• Fantastic Futures: https://www.fantasticfuture.com.au/

Deciding whether to attempt a Vaginal Birth After Cesarean (VBAC) is a complex and personal process, influenced by numerous factors. Here are some key aspects to consider:

MEDICAL FACTORS

• Reason for previous caesarean: The type and reason for the prior caesarean play a crucial role. Lower-segment transverse caesareans have a higher VBAC completion rate compared to classical or vertical c-sections. That doesn’t mean that these scars necessarily exclude you from VBAC; they just have different risk factors. Additionally, if the previous c-section wasn't due to problems with uterine integrity, VBAC is generally considered safe.

• Current pregnancy health: Maternal health during the current pregnancy, including foetal positioning: i.e. transverse lie is not normally conducive to vaginal birth, presence of any medical conditions, and overall well-being, is crucial in assessing risks and benefits of VBAC.

• Support team: Having a supportive healthcare team, any obstetrician and midwife must not only be familiar with VBAC but also have the same philosophy around birth and VBAC as you, which is essential for providing informed guidance and care throughout the process. This is vital for avoiding the bait-and-switch often experienced by women seeking VBAC support. (More on that later.)

PERSONAL FACTORS

• Informed decision-making: Access to accurate and objective information about VBAC completion rates, potential risks and benefits, and alternative birth options is vital for making an informed and confident decision.

• Emotional preferences: Weighing your desires for a natural birth experience against potential anxieties or fears surrounding risks associated with VBAC and RCS is crucial. Seeking therapy to heal your previous birth before birthing again is highly advisable.

MATERNAL MENTAL HEALTH AND THE ISSUES WITH A HEALING OR REDEMPTIVE BIRTH AFTER CAESAREAN

The mental health impacts of caesarean sections (C-sections) that weren't solely based on choice can be complex and varied. Here's a breakdown of some potential factors to consider:

Factors influencing mental health impacts:

• Reason for C-section: Emergency C-sections due to foetal distress or maternal complications can bring additional anxieties and fears about the baby's well-being or future health. Planned C-sections for non-medical reasons (breech presentation, etc.) might involve feelings of grief or loss of control over the birth experience.

• Birth experience: Negative experiences during surgery or recovery, incidences of obstetric violence such as feeling coerced, unheard or unsupported by medical staff, can contribute to feelings of frustration, isolation, and even medical trauma.

• Pre-existing mental health conditions: Women with existing conditions like anxiety or depression might be more vulnerable to experiencing postpartum mood disorders after an unexpected C-section.

• Social and cultural expectations: Societal pressure to have a "natural" birth can lead to feelings of guilt or shame after a C-section, hindering the grieving and acceptance process.

Potential mental health impacts:

• Post-traumatic stress disorder (PTSD): Flashbacks, nightmares, and intrusive thoughts related to the C-section experience.

• Anxiety and depression: Worries about the baby's health, future pregnancies, or body image changes can lead to anxiety and depressive symptoms.

• Grief and loss: Grieving the birth experience they envisioned and feeling a sense of loss of control can be emotionally challenging.

• Bonding difficulties with the baby: The physical and emotional recovery from surgery can sometimes make it harder to bond with the newborn.

• Body image concerns: Scars or changes in body shape after surgery can contribute to negative body image and self-esteem issues.

The experience of birth trauma and obstetric violence can leave deep emotional and psychological scars, profoundly impacting subsequent childbirth decisions like choosing repeat caesarean sections (RCS) or a vaginal birth after caesarean (VBAC). Fortunately, working with a skilled birth trauma therapist can play a crucial role in healing from these experiences, paving the way for informed and empowered choices about future births. This is true for both parents. Birthing partners can also experience birth trauma and perinatal trauma. 

PROCESSING THE TRAUMA AND THE FEAR

Birth trauma therapists create a safe and supportive space for individuals to delve into the complex emotions associated with their traumatic experience, whether it's fear, anger, grief, guilt, or dissociation. By acknowledging and validating these emotions, therapists help individuals begin to process the trauma, reducing anxiety and fear around future pregnancies and births. This newfound emotional clarity can empower individuals to explore both RCS and VBAC options with a more open mind.

ADDRESSING OBSTETRIC VIOLENCE

Therapists play a vital role in helping individuals who have experienced obstetric violence, which encompasses a range of abusive practices during childbirth, from verbal humiliation to physical harm. By validating the abuse and dismantling self-blame, therapists lead individuals to reclaim their agency and personal narrative. This process is crucial for healing and can motivate individuals to advocate for their rights and hold perpetrators accountable, creating a ripple effect of systemic change.

INFORMED DECISION MAKING FOR BIRTH CHOICES

Therapists can, if also appropriately qualified, provide accurate and unbiased information about birth options, risks, and benefits, enabling individuals to make informed decisions about RCS or VBAC. This includes exploring personal preferences against medical recommendations, understanding the potential impact of each choice on mental and emotional well-being, and navigating complex legal or medical systems surrounding obstetric violence. This empowers individuals to take ownership of their choices and feel confident in their decisions.

BUILDING CONFIDENCE AND CONTROL

Birth trauma and obstetric violence can erode trust and control over one's body and birth experience. Therapists help individuals rebuild confidence and self-advocacy skills, guiding them to participate actively in decision-making during prenatal care and labour. This newfound confidence can be transformative, making VBAC feel more achievable and reducing the perceived need for an RCS solely due to fear or lack of control.

SUPPORTING VBAC WHEN CHOSEN

For individuals considering VBAC, therapists offer specific support and guidance throughout the journey. This might involve developing coping mechanisms for managing pain and fear during labour, practising relaxation techniques, connecting with VBAC support groups, and navigating potential challenges with healthcare providers. This dedicated support network can significantly increase the chances of a successful VBAC experience, fostering feelings of accomplishment and empowerment.

OVERALL WELL-BEING AND HEALING

Regardless of the ultimate birth choice, processing birth trauma and obstetric violence with an experienced therapist has a profound impact on overall mental and emotional well-being. This can involve alleviating symptoms of post-traumatic stress, anxiety, depression, and isolation. Improved mental health contributes to a more positive and empowering pregnancy and birth experience, regardless of the delivery method.

The journey of healing from birth trauma and obstetric violence is unique to each individual. Working with a birth trauma therapist provides invaluable support and guidance along this path, fostering resilience, empowerment, and a renewed sense of agency over one's body and reproductive healthcare. This journey doesn't pressure anyone towards a specific birthing path but instead equips individuals with the tools and confidence to make informed choices that align with their values and well-being.

Explore the journey to healing and empowerment at www.fantasticfutures.com.au. Discover invaluable resources for overcoming birth trauma (BT) and perinatal depression (PND), and educate yourself with the essential guide on the '10 Things About Obstetric Violence.' Empower your path to recovery and awareness with these specialized tools and knowledge.

Family and Friends: Lean on your trusted loved ones for emotional support, childcare assistance, and practical help during pregnancy and after birth. Consider sharing your needs openly, allowing them to play an active role in your journey.

Healthcare Providers: Choose a healthcare team that respects your informed choices and offers unbiased information about both VBAC and RCS. Seek a doctor or midwife experienced in VBAC support who can answer your questions and guide you through the process with confidence and who believes the same thing you do about birth.

By actively building your support network, you can approach the decision between RCS and VBAC with confidence and clarity, knowing that you are surrounded by love, information, and unwavering support every step of the way.

Gather information: Research and educate yourself on VBAC through reliable sources like your healthcare provider, support groups, and reputable online resources.

1. Discuss with your chosen and philosophically aligned healthcare team: Have open and honest conversations with your obstetrician or midwife about your VBAC or RCS aspirations, medical history, and any concerns you might have.

2. Weigh the risks and benefits: Discuss and understand the potential risks associated with VBAC and RCS, and compare them to the benefits.

3. Consider your personal preferences: Reflect on your emotional and physical priorities for childbirth and how each mode of birth aligns with your hopes and anxieties. Making sure these are not impacted by fear and past experiences by seeking therapeutic support.

4. Make an informed decision: Ultimately, the decision is yours and your partners. Choose the option that feels safest and most empowering for you both, based on your informed understanding of all factors involved.

Welcome to this interactive quiz designed to help you learn about the differences between VBAC and planned Caesarean birth! Remember, this quiz is for educational purposes only and cannot replace the personalised advice of your healthcare provider.

Remember, there's no "right" or "wrong" answer when it comes to choosing your birthing path. The most important thing is to feel confident and comfortable with your decision, knowing it's the best choice for you and your baby.